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Tracking SARS-CoV-2 in sewers and in patients

Unique coupling of virus trends above and below the ground

It recently became possible to detect SARS-CoV-2 in sewage water, making it possible to see the extent to which the virus is still present in particular districts or entire cities. Linking those data to data about patients with Covid-19 makes it possible to establish a more complete picture of the spread of the disease in the population. A consortium consisting of, among others, the Erasmus Medical Centre (Virology, Family Medicine, Medical Informatics), STOWA, RHDHV, Partners4UrbanWater, water authorities and KWR Water Research Institute will be conducting further investigations in the Rijnmond area in more detail, and it has received funding for that purpose from organisations including the Dutch Foundation for Applied Water Research (STOWA), the Erasmus Foundation and the Water Technology Top Consortium for Knowledge and Innovation. This project will involve looking at, among other things, how we can detect and measure Covid-19 as efficiently as possible in particular districts or entire cities, and how we can display that information in an easy-to-understand ‘dashboard’ to help with decisions about containment measures.

During the outbreak of the new viral disease Covid-19, it emerged that the virus is also excreted via faeces and enters the sewers, where the virus RNA can be detected in communal waste water.

What are the risks?

This finding raises questions about possible health risks for people directly or indirectly exposed to sewage water such as ‘how long does the virus RNA signal remain intact in sewage water?’ Or in sludge? Is it removed in the wastewater treatment plant? Does it enter receiving surface water bodies via overflows or faulty connections? Does that pose a health risk? These questions make up the ‘risk‘ component of this project.

What are the opportunities?

In addition, this finding also provides opportunities to follow the trends in the prevalence of the virus by looking at sewage water, allowing the trend in an entire city (or part of a city) to be determined in a single operation. In this way, the sewage water delivers valuable information that allows us to see whether the virus is starting to circulate more as society emerges from the lockdown. In order to use the surveillance of sewage water for the reliable detection of any rise or fall in infections, it is important to establish a good link with Covid‑19 trends in the population.

Graph illustrating the Corona RNA concentration in sewage (orange) and the number of Corona hospital admissions in Amsterdam (source:77 KWR research data)

Graph showing the relationship between the number of gene copies of the SARS-CoV-2 virus and the number of hospital admissions in Amsterdam

Investigating and monitoring Covid-19 in sewage water

This project will involve looking at, among other things, how we can detect and measure Covid-19 as efficiently as possible in particular districts or entire cities, and how we can display that information in an easy-to-understand ‘dashboard’ to help with decisions about containment measures.

Risk: Use the new method for SARS-CoV-2 RNA in communal waste water to investigate prevalence in effluent, sludge, overflows, rainwater sewers with faulty connections and other relevant matrices, and perform a quantitative microbiological risk analysis.

Opportunity: Further develop and integrate a combination of different technologies in a unique monitoring system in order to determine the best way to detect trends in Covid-19 in the population as early as possible. This will be done with four parallel real-time systems:

  1. Low-threshold testing by GPs
  2. Monitoring clinical data in medical records (syndrome surveillance)
  3. Reports from biology laboratories
  4. Sampling of sewage water

The project will be conducted by a consortium consisting of the organisations listed in the table.

Organisation Role in the project
KWR Water Research Institute Wastewater surveillance, hydro-informatics
Erasmus Medical Centre (Virology, Family Medicine, Medical Informatics) ‘above-ground’ surveillance
Partners4urbanwater Sewer models, hydro-informatics
STOWA Coordination for the water authorities, research design and supervision of risk component
Delfland water authority High-resolution information about wastewater systems
Hollandse Delta water authority High-resolution information about wastewater systems
Schieland en Krimpenerwaard water authority High-resolution information about wastewater systems
Royal Haskoning DHV Data science, linkage of data and information systems
Municipalities (yet to be determined, this depends on the selection of areas for research) Drainage infrastructure, high-resolution measuring programme

A supervisory committee will be set up for this research consisting of one participant from each of the partners, as well as the municipal authorities, the Erasmus Foundation, the National Institute of Public Health and the Environment (RIVM), Wageningen University & Research and RIONED. The results will be shared with direct stakeholders (water authorities, STOWA, RIONED, the Dutch Union of Water Authorities (UvW), the A&O Fund, RIVM, the municipal health service of Rijnmond and – in consultation – in scientific and social media. In order to involve the general public, we plan to produce a series of infographics & animations to broaden the understanding of the research using general media and social media outlets. In addition, we plan to establish an online environment (dashboard/app) in which the various surveillance systems will be integrated so that the circulation of the virus can be monitored in real time.

This Top Consortium for Knowledge and Innovation (TKI) project is being organised in parallel with an ErasmusMC project for research with GPs and clinical laboratories that is being funded by the Erasmus Foundation.

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